Impact of distal aortic and visceral perfusion on liver function during thoracoabdominal and descending thoracic aortic repair.
OBJECTIVE
We examined the impact of distal aortic and visceral perfusion on liver function during thoracoabdominal and descending thoracic aortic repair.


METHODS
Between January 1991 and July 1996, 367 patients underwent thoracoabdominal and descending thoracic aortic repair. Baseline and postoperative total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase, fibrinogen, prothrombin time (PT), and partial thromboplastin time (PTT) were measured for 286 patients. We examined the impact of distal aortic and direct visceral perfusion on liver function-related clinical laboratory values. Univariate and multivariate statistical methods for categorical and continuous variables were used.


RESULTS
In categorical analysis, type II thoracoabdominal aortic aneurysm, history of hepatitis, and emergency presentation had a statistically significant multivariate association with abnormal laboratory values. In continuous-distributed multivariate data analysis, type II thoracoabdominal aortic aneurysm and visceral perfusion were statistically significant predictors of postoperative alkaline phosphatase, PT, and PTT. Type II aneurysms increased postoperative liver function-related laboratory values significantly above other aneurysm types (alkaline phosphatase, +114 IU, p < 0.0001; PT, +1.99 seconds, p < 0.02; PTT, +6.7 seconds, p < 0.03). Visceral perfusion was associated with a concomitant decrease (alkaline phosphatase, -101.2 IU, p < 0.0001; PT, -1.8 seconds, p < 0.07; PTT, -5.6 seconds, p < 0.02).


CONCLUSIONS
Visceral perfusion negates the rise in postoperative liver function-related clinical laboratory values associated with type II thoracoabdominal aortic aneurysm repair.
Safi
H J
HJ
Baylor College of Medicine, Methodist Hospital, Houston, TX 77030, USA.
Miller
C C
CC
Yawn
D H
DH
Iliopoulos
D C
DC
Subramaniam
M
M
Harlin
S
S
Letsou
G V
GV
D000469:Alkaline Phosphatase / Q000378:metabolism; D001011:Aorta / Q000502:physiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001219:Aspartate Aminotransferases / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008099:Liver / Q000201:enzymology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D012039:Regional Blood Flow; D014781:Viscera / Q000098:blood supply*
D005340:Fibrinogen; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase